title: Laparoscopic and open inguinal hernia repair with alloplastic material: do the subjective and objective parameters differ in the long-term course?
abstract: BACKGROUND
  Management with alloplastic materials has become the standard procedure in inguinal hernia surgery. The aim of this study was to evaluate the long-term results after laparoscopic and open groin hernia repair with alloplastic material in a large patient population.
  
  
  METHODS
  We included patients in the study who underwent elective laparoscopic total extraperitoneal (TEP) inguinal hernia repair or Lichtenstein surgery between January 1998 and December 2004 for either unilateral or bilateral inguinal hernia. Patient data were recorded by a prospective online data recording system and evaluated after a minimum follow-up time of 12 (12 to 103) months by standardized questionnaires. Both objective (chronic pain, chronic dysesthesia, recurrence, and postoperative recovery) and subjective (cosmetic result, scar formation, and the choice of surgical procedure) parameters were surveyed.
  
  
  RESULTS
  Seven hundred eighty-two patients with 923 inguinal hernias underwent surgery in the study period. Five hundred fifty-three patients returned the questionnaire; 62 died during the follow-up. In the remaining 491 patients, TEP was used in 292 patients (375 hernias) and the Lichtenstein procedure in 199 patients (206 hernias). TEP was significantly superior to the Lichtenstein procedure for 2 objective parameters: chronic dysesthesia and return to normal work. Regarding the subjective parameters, TEP was superior in the cosmetic results and the choice of surgical procedure. 3.1% of the patients after TEP versus 8.5% after Lichtenstein were dissatisfied with the cosmetic result (P=0.008). If secondary inguinal hernia surgery were required, 89.4% of the patients would choose TEP again versus 76.1% the Lichtenstein procedure (P<0.001).
  
  
  CONCLUSIONS
  Whereas the Lichtenstein procedure was not significantly better in any of the evaluated parameters, TEP was superior especially in the subjective parameters.
authors.affiliation: Department of General, Vascular and Thoracic Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, Germany. johannes.lauscher@charite.de
authors.forename: Johannes Christian
authors.initials: JC
authors.lastname: Lauscher
authors.forename: Kamal
authors.initials: K
authors.lastname: Yafaei
authors.forename: Heinz Johannes
authors.initials: HJ
authors.lastname: Buhr
authors.forename: Jörg-Peter
authors.initials: JP
authors.lastname: Ritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011098:Polyglactin 910; D011126:Polypropylenes; D011183:Postoperative Complications; D012008:Recurrence; D013526:Surgical Mesh; D055815:Young Adult
chemical_list: D011126:Polypropylenes; D011098:Polyglactin 910